A Retrospective Analysis of Gender-Based Difference in Adherence to Influenza Vaccination during the 2018-2019 Season

Gender and vaccination: understanding the multifaceted role of a multidimensional conceptualization of vaccine hesitancy

Popular press and academic articles alike speculate that gender influences vaccine receipt, but they often disagree whether men or women are less likely to become vaccinated. In the current article, we further test the relation of gender and vaccination in four datasets, and we assess the mediating role of vaccine hesitancy dimensions. Our results demonstrate that: (1) gender has significant relations with several vaccine hesitancy dimensions, which are mixed between both women and men having negative perceptions regarding vaccination; (2) gender does not significantly relate to flu and COVID-19 vaccination willingness or receipt, but women were more likely to receive other vaccines; and (3) a significant indirect effect did emerge in the two datasets collected after widespread access to the COVID-19 vaccine, such that the perception that vaccines cause health risks mediates the relation of gender with flu vaccination willingness as well as COVID-19 vaccination willingness and receipt. Our discussion integrates these findings with models of preventative behaviors and identifies directions for future research.

Challenges in assessing the immunization status of adults in Germany-lessons from a population-based VACCELERATE survey on polio vaccination

PURPOSE

Considering the re-emergence of poliomyelitis (PM) in non-endemic regions, it becomes apparent that vaccine preventable diseases can rapidly develop epi- or even pandemic potential. Evaluation of the current vaccination status is required to inform patients, health care providers and policy makers about vaccination gaps.

METHODS

Between October 28 2022 and November 23 2022, 5,989 adults from the VACCELEREATE Volunteer Registry completed an electronic case report form on their previous PM vaccine doses including number, types/-valencies and the time of administration based on their vaccination records. A uni-/multivariable regression analysis was performed to assess associations in participant characteristics and immunization status.

RESULTS

Among German volunteers (n = 5,449), complete PM immunization schedule was found in 1,981 (36%) participants. Uncertain immunization, due to unknown previous PM vaccination (n = 313, 6%), number of doses (n = 497, 9%), types/-valencies (n = 1,233, 23%) or incoherent immunization schedule (n = 149, 3%) was found in 40% (n = 2,192). Out of 1,276 (23%) participants who reported an incomplete immunization schedule, 62 (1%) never received any PM vaccine. A total of 5,074 (93%) volunteers reported having been vaccinated at least once and 2,087 (38%) indicated that they received vaccination within the last ten years. Female sex, younger age, as well as availability of first vaccination record were characteristics significantly associated with complete immunization (p < 0.001).

CONCLUSION

Full PM immunization schedule was low and status frequently classified as uncertain due to lack of details on administered doses. There is an obviousneed for improved recording to enable long-term access to detailed vaccination history in the absence of a centralized immunization register.

Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

Trends in Influenza Vaccination Rates among a Medicaid Population from 2016 to 2021

Seasonal influenza is a leading cause of death in the U.S., causing significant morbidity, mortality, and economic burden. Despite the proven efficacy of vaccinations, rates remain notably low, especially among Medicaid enrollees. Leveraging Medicaid claims data, this study characterizes influenza vaccination rates among Medicaid enrollees and aims to elucidate factors influencing vaccine uptake, providing insights that might also be applicable to other vaccine-preventable diseases, including COVID-19. This study used Medicaid claims data from nine U.S. states (2016-2021], encompassing three types of claims: fee-for-service, major Medicaid managed care plan, and combined. We included Medicaid enrollees who had an in-person healthcare encounter during an influenza season in this period, excluding those under 6 months of age, over 65 years, or having telehealth-only encounters. Vaccination was the primary outcome, with secondary outcomes involving in-person healthcare encounters. Chi-square tests, multivariable logistic regression, and Fisher's exact test were utilized for statistical analysis. A total of 20,868,910 enrollees with at least one healthcare encounter in at least one influenza season were included in the study population between 2016 and 2021. Overall, 15% (N = 3,050,471) of enrollees received an influenza vaccine between 2016 and 2021. During peri-COVID periods, there was an increase in vaccination rates among enrollees compared to pre-COVID periods, from 14% to 16%. Children had the highest influenza vaccination rates among all age groups at 29%, whereas only 17% were of 5-17 years, and 10% were of the 18-64 years were vaccinated. We observed differences in the likelihood of receiving the influenza vaccine among enrollees based on their health conditions and medical encounters. In a study of Medicaid enrollees across nine states, 15% received an influenza vaccine from July 2016 to June 2021. Vaccination rates rose annually, peaking during peri-COVID seasons. The highest uptake was among children (6 months-4 years), and the lowest was in adults (18-64 years). Female gender, urban residency, and Medicaid-managed care affiliation positively influenced uptake. However, mental health and substance abuse disorders decreased the likelihood. This study, reliant on Medicaid claims data, underscores the need for outreach services.

Vaccine promotion strategies in community pharmacy addressing vulnerable populations: a scoping review

CONTEXT

Social determinants of health are drivers of vaccine inequity and lead to higher risks of complications from infectious diseases in under vaccinated communities. In many countries, pharmacists have gained the rights to prescribe and administer vaccines, which contributes to improving vaccination rates. However, little is known on how they define and target vulnerable communities.

OBJECTIVE

The purpose of this study is to describe how vulnerable communities are targeted in community pharmacies.

METHODS

We performed a systematic search of the Embase and MEDLINE database in August 2021 inspired by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols (PRISMA ScR). Articles in English, French or Spanish addressing any vaccine in a community pharmacy context and that target a population defined as vulnerable were screened for inclusion.

RESULTS

A total of 1039 articles were identified through the initial search, and 63 articles met the inclusion criteria. Most of the literature originated from North America (n = 54, 86%) and addressed influenza (n = 29, 46%), pneumococcal (n = 14, 22%), herpes zoster (n = 14, 22%) or human papilloma virus vaccination (n = 14, 22%). Lifecycle vulnerabilities (n = 48, 76%) such as age and pregnancy were most often used to target vulnerable patients followed by clinical factors (n = 18, 29%), socio-economical determinants (n = 16, 25%) and geographical vulnerabilities (n = 7, 11%). The most frequently listed strategy was providing a strong recommendation for vaccination, promotional posters in pharmacy, distributing leaflet/bag stuffers and providing staff training. A total of 24 barriers and 25 facilitators were identified. The main barriers associated to each vulnerable category were associated to effective promotional strategies to overcome them.

CONCLUSION

Pharmacists prioritize lifecycle and clinical vulnerability at the expense of narrowing down the definition of vulnerability. Some vulnerable groups are also under targeted in pharmacies. A wide variety of promotional strategies are available to pharmacies to overcome the specific barriers experienced by various groups.

Using the theory of planned behavior to assess willingness and attitudes towards COVID-19 vaccination among a predominantly white U.S. college sample

Objective

Through the lens of behavioral models such as the Theory of Planned Behavior (TPB) and the Health Belief Model, the present study (1) investigated U.S. university students' willingness to receive the COVID-19 vaccine and (2) examined predictors (e.g. demographics, past vaccine experience, TPB constructs) of vaccine willingness.

Method

University students (n = 170) completed a survey assessing demographics, health behaviors, attitudes, perceived severity/susceptibility, norms, and vaccine intentions related to the COVID-19 pandemic. Data were collected from April 2020 through July 2020.

Results

Overall, 56.5% of participants indicated that they would be willing to receive the COVID-19 vaccine once it is available, 39.4% were unsure of whether they would receive the vaccine, and 4.1% indicated they would not receive the vaccine. Multinomial logistic regression indicated that greater adherence to CDC guidelines (p = .030) and greater perceived pro-vaccine norms (p < .001) predicted greater vaccine willingness.

Conclusions

Results from this study are consistent with previous literature on vaccine hesitancy, whereby normative beliefs and adherence to CDC guidelines were found to be determinants of vaccine willingness. To reduce transmission of the COVID-19 pandemic, interventions aimed at promoting positive attitudes towards vaccination should aim to incorporate these observed determinants.

Factors associated with COVID-19 vaccine uptake in a US/Mexico border community: demographics, previous influenza vaccination, and trusted sources of health information

Background

COVID-19 vaccine uptake has been uneven, particularly across racial/ethnic and age groups. This study seeks to understand factors associated with COVID-19 vaccine uptake in a large cross-sectional sample of predominantly Latinos/Latinas individuals living near the US/Mexico border.

Methods

Data are extracted from a 176-item survey conducted as part of a parent study focused on the co-creation of a COVID-19 testing program for underserved communities developed through a partnership between an academic institution and a Federally Qualified Health Center. The following participant variables were examined: health history, COVID-19 symptoms, COVID-19 testing and vaccine experiences, and perceptions of sources of health information. Participant characteristics were compared using chi-square tests. Multivariate logistic regressions were used for the final statistical model.

Results

From 1 May 2021 to 30 April 2022, 4,964 adults, 66% of whom were identified as women, completed the survey. Approximately 80% of participants reported having received at least one COVID-19 vaccine. Female sex, older age, Hispanic/Latino(a) ethnicity, previous influenza vaccination, advanced education, and perceived elevated risk of COVID-19 were significantly (p < 0.05) associated with having received a COVID-19 vaccine. Regarding sources of health information, individuals who indicated they trust their doctor, healthcare provider, or the US government "a great deal" were more likely to have received a COVID-19 vaccine compared to individuals who indicated that they trusted these sources "not at all." In contrast, those who reported having "a great deal" of trust in their faith leader or their social media contacts were significantly less likely to have received a COVID-19 vaccine than those who reported that they trusted these sources "not at all."

Conclusion

Sex, education, past influenza vaccination, perceived risk of COVID-19 infection, and trust in specific sources of information were correlated with the uptake of COVID-19 vaccination. Additional research is needed to better understand why this confluence of factors, particularly the unique findings about trusted sources of information, are associated with vaccine uptake. Understanding these associations, specifically within underserved, Latino/Hispanic communities, is an important first step to inform efforts aimed at increasing and sustaining COVID-19 vaccine uptake and adoption of other public health interventions.

Influenza vaccination from the perspective of health care workers at university hospitals

BACKGROUND

The influenza vaccination rate of healthcare workers (HWs) in Poland is low. Before implementing methods for promoting influenza vaccination, it is crucial to identify attitudes towards vaccination. We aimed to examine the knowledge and attitudes towards influenza vaccination of HWs at university hospitals. Moreover, we evaluated the incentives for getting influenza vaccination among HWs.

METHODS

From September 2020 to October 2020, we surveyed HWs in one children's hospital and two adults' hospitals in Warsaw (Poland). We included only fully and correctly completed surveys into final analysis.

RESULTS

A total of 950 questionnaires (85% women, 45% <40 years old, 33% physicians and 48% nurses, 56% working in a children's hospital) were evaluated. Of all HWs, 25% declared they were vaccinated and 54% planned to get vaccinated in the next season. We have analyzed attitudes towards influenza vaccination and motivations to get vaccinated.

CONCLUSIONS

Among HWs in academic hospitals, males, people <40 years old, physicians and those working in children's hospital are more likely to get vaccinated and their attitudes towards influenza vaccination are more positive. Of those less likely to get vaccinated, people >40 years old and nurses could be effectively persuaded by free and on-site influenza vaccination. Moreover, free access to vaccination is the strongest motivator for vaccination among all HWs. The attitudes towards mandatory influenza vaccination differ sharply among HWs-while physicians are ready to accept it, nurses are not.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04569019.

Determinants of Flu Vaccine Uptake Among the General Population in Saudi Arabia: A Study Based on the Health Belief Model

Background and objective Recently, influenza has emerged as a significant public health concern worldwide, including in Saudi Arabia. Vaccination against the flu is widely recognized as a crucial preventive measure to reduce morbidity and mortality associated with the virus. However, the uptake of flu vaccines among the general population in Saudi Arabia still remains low. In light of this, this study aimed to examine the determinants of influenza vaccine uptake in Saudi Arabia by using the Health Belief Model (HBM). Methods This cross-sectional study was conducted among adults living in all regions of Saudi Arabia by using an online self-administered questionnaire based on the HBM. The questionnaire inquired about demographics, knowledge about influenza, knowledge about vaccines, and beliefs/barriers. It was distributed via social media platforms, including WhatsApp, Twitter, and Instagram. IBM SPSS Statistics software version 29 (IBM Corp., Armonk, NY) was used for statistical analyses, and both the Chi-square test and logic regression analyses were applied to determine associations between explanatory and response variables, with the level of significance set at p<0.05. Results This study enrolled a total of 1040 participants, and the majority were Saudi nationals (96.9%). Of note, 66.2% of the participants were males, and the rest were females. Most of the participants were employed by governmental institutions (42.0%), had bachelor's degrees (58.4%), had never worked in the health sector (70.2%), and earned above 10,000 Saudi riyals per month (62.1%). Over half (55.7%) of participants had taken the flu vaccine at the time of this study. Working in the healthcare sector was associated with increased flu vaccine uptake [adjusted odds ratio (aOR): 3.84, p<0.001]. The likelihood of getting the flu vaccines was greater among men (aOR: 1.38, p=0.027), and obesity was associated with lower flu vaccine uptake (aOR: 0.29, p=0.034). Having contact with people with flu, having had flu in the past, and experiencing severe flu complications (aOR: 4.71, p=0.029; aOR: 0.13, p=0.006; and aOR: 0.29, p=0.033, respectively) were significantly associated with the flu vaccine uptake among our study participants. Perceived potential risks of the flu vaccine were also associated with taking the flu vaccine (aOR: 0.213, p=0.042). There was a significant association between seeing an advertisement for the flu vaccine and the likelihood of taking the vaccine (aOR: 5.488, p=0.042). Conclusion This study found that certain sociodemographic factors are associated with flu vaccine uptake. These factors included contact with flu-infected individuals, past experiences with flu, perceived risks, and exposure to flu vaccine advertisements. Improving healthcare accessibility, conducting awareness campaigns, and implementing workplace initiatives are recommended to address the issues related to flu vaccine uptake.

Associations Between General Vaccine Hesitancy and Healthcare Access Among Arkansans

BACKGROUND

Vaccines provide protection against numerous diseases that can cause serious illness and death. However, vaccine hesitancy threatens to undermine progress in reducing preventable diseases and illness. Vaccine hesitancy has been shown to vary by sociodemographic characteristics. However, studies examining associations between healthcare access and vaccine hesitancy are lacking.

OBJECTIVE

Using a statewide random sample of Arkansas adults, we examined the relationship between general vaccine hesitancy and healthcare access.

DESIGN

From July 12 to 30, 2021, participants were contacted by landlines and cellular phones using random digit dialing.

PARTICIPANTS

A total of 1500 Arkansas adults were surveyed. Black/African American and Hispanic/Latinx adults were oversampled to ensure adequate representation. The survey had a cooperation rate of 20%.

MAIN MEASURES

The dependent variable was an ordinal measure of general vaccine hesitancy. Age, gender, race, education, relationship status, and rural/urban residence were included in the model. Healthcare access was measured across four domains: (1) health insurance coverage; (2) having a primary care provider (PCP); (3) forgoing care due to cost; and (4) time since last routine checkup. The relationship between general vaccine hesitancy and healthcare access was modeled using ordinal logistic regression, controlling for sociodemographic characteristics.

KEY RESULTS

Mean age was 48.5 years, 51.1% were women, 28% reported a race other than White, and 36.3% held a bachelor's degree or higher. Those with a PCP and those with health insurance had approximately two-thirds the odds of being more hesitant ([OR=0.63, CI=0.47, 0.84] and [OR=0.68; CI=0.49, 0.94]) than those without a PCP and those without health insurance. Participants reporting a routine checkup in the last 2 years were almost half as likely to be more hesitant than those reporting a checkup more than 2 years prior (OR=0.58; CI=0.43, 0.79).

CONCLUSIONS

Results suggest improving access to health insurance, PCPs, and routine preventative care services may be critical to reducing vaccine hesitancy.

Predictors of Influenza and Pneumococcal Vaccination Among Participants in the Women's Health Initiative

OBJECTIVE

Older adults typically experience higher rates of severe disease and mortality than the general population after contracting an infectious disease. Vaccination is critical for preventing disease and severe downstream outcomes; however, vaccination rates among older adults are suboptimal. We assessed predictors associated with pneumococcal and seasonal influenza vaccination among older women.

METHODS

We used data from the Women's Health Initiative, a nationwide cohort of women. We ascertained seasonal influenza and pneumococcal vaccination status through a questionnaire administered in 2013. We limited analyses to women aged ≥65 years at questionnaire administration. We used logistic regression to estimate associations between demographic, lifestyle, and health-related factors and vaccination and explored stratification by race.

RESULTS

Of participants who responded to each question, 84.3% (n = 60 578) reported being vaccinated for influenza and 85.5% (n = 59 015) for pneumonia. The odds of reporting influenza vaccination were significantly lower among non-Hispanic Black participants than among non-Hispanic White participants (odds ratio [OR] = 0.53; 95% CI, 0.49-0.58), women with no health insurance versus private health insurance (OR = 0.61; 95% CI, 0.54-0.68), and women living in rural versus urban settings (OR = 0.84; 95% CI, 0.73-0.96). Current smoking, lower education levels, and having comorbid conditions were associated with lower likelihood of being vaccinated for influenza (than not); past pneumonia diagnosis and being currently married were associated with a higher likelihood. We observed similar associations for pneumococcal vaccination coverage.

CONCLUSIONS

These findings reinforce the need to enact policy and implement programs to improve access to, education and awareness about, and provider recommendations for these critical disease-prevention tools. Results from our study should guide strategies for SARS-CoV-2 vaccination.

Associations between Influenza Vaccination and Health Care Access among Adults in the United States

Few studies have investigated the relationship between influenza vaccination and health care access. Furthermore, despite the well-documented disparities in vaccine coverage for communities of color, few studies have examined how experiences of discrimination may influence vaccine uptake. To fill this gap in the literature, this study examined associations between 5-year influenza vaccination rates and sociodemographic characteristics, health care access, and racial discrimination. Age, race/ethnicity, education, health care coverage, primary care provider, no medical care due to cost, and routine doctor checkups were significant correlates of 5-year influenza vaccination. In contrast to previous studies, discrimination scores were not a significant correlate of regular influenza vaccination. Respondents who reported forgoing care due to cost were less likely to report vaccination every year out of the last 5 years compared to all of the less frequent categories combined, demonstrating a more complex association between sometimes not being able to afford medical care and influenza vaccination. Future research should examine the relationship between influenza vaccination uptake, racial discrimination, and forgone care due to cost to enhance resources and messaging for influenza vaccination uptake.

Healthcare Access and Experiences of Racial Discrimination as Predictors of General Vaccine Hesitancy

The literature regarding vaccine hesitancy is limited to specific vaccines rather than general vaccine hesitancy. No studies have examined the relationship of general vaccine hesitancy to healthcare access and experiences of racial discrimination. This study fills gaps by examining: (1) socio-demographic factors; (2) associations between healthcare access; and (3) experiences with racial discrimination and general vaccine hesitancy. Survey data were obtained from 2022 US adults from 7 September to 3 October 2021. Racial and ethnic minority populations were oversampled. Age, gender, race, and education were predictors of vaccine hesitancy. Asian respondents had less than two-thirds the odds of being vaccine hesitant. Healthcare access was associated with vaccine hesitancy. Not having health insurance coverage, not having a primary care provider, and not seeing a provider for a routine check-up in the past two years were associated with higher vaccine hesitancy. For every one-point increase in racial discrimination score (0-45), the odds of being more vaccine hesitant increased by a factor of 1.03. The findings demonstrate that policy, systems, and environmental factors are critical to addressing vaccine hesitancy. Given the associations between vaccine hesitancy and racial discrimination and healthcare access, more attention should be given to inequities in the healthcare systems in order to address vaccine hesitancy.

Willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster - A pre-COVID-19 exploration among the older adult population

BACKGROUND

Older adults are at increased risk for adverse health outcomes when having an influenza, pneumococcal disease, pertussis, or herpes zoster infection. Despite the ability of vaccinations to prevent these adverse outcomes, vaccination coverage is low in the European Union. This study aimed to explore the sociodemographic, lifestyle, and health-related characteristics associated with vaccination willingness for these vaccine-preventable diseases.

METHODS

Cross-sectional data from wave 6 (years 2013-2017) of the population-based Doetinchem Cohort Study was analysed, with 3063 participants aged 46-86 years included. The outcome was the self-reported willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster (willing, neutral, not willing). Multinomial logistic regression was used to investigate the socio-demographic, lifestyle and health characteristics associated with vaccination willingness.

RESULTS

For influenza 36 % was willing to get vaccinated, 35 % was neutral and 28 % was not willing to get vaccinated. The willingness to get vaccinated for the relatively unfamiliar vaccine-preventable diseases was lower: 26 % for pneumococcal disease (neutral: 50 %, not willing: 23 %), 26 % for pertussis (neutral 53 %, not willing: 22 %), and 23 % for herpes zoster (neutral 54 %, not willing: 24 %). A relative lower willingness was found among those 46-64 years old (compared to those 65 years or older). Women, having a high SES, being employed and having a good health were all associated with lower willingness to get vaccinated, which was the case for all vaccine-preventable diseases.

CONCLUSIONS

Older adults were generally more willing to get vaccinated against influenza than for the three less familiar diseases. Characteristics of those less willing may be used to improve strategies to increase vaccination coverage. Additional studies are needed to investigate the willingness to get vaccinated during and after the COVID-19 pandemic that may have changed the feel of urgency for vaccination.

Understanding COVID-19 vaccine hesitancy: A cross-sectional study in Malang District, Indonesia

Introduction

Vaccine hesitancy could undermine efforts to reduce incidence of coronavirus disease 2019 (COVID-19). Understanding COVID-19 vaccine hesitancy is crucial to tailoring strategies to increase vaccination acceptance. This study aims to investigate the prevalence of and the reasons for COVID-19 vaccine hesitancy in Malang District, Indonesia.

Methods

Data come from a cross-sectional study among individuals aged 17-85 years old (N = 3,014). Multivariate ordered logistic regression was used to identify factors associated with postponing or refusing COVID-19 vaccines. The Oxford COVID-19 vaccine hesitancy scale was used to measure vaccine hesitancy. A wide range of reasons for hesitancy, including coronavirus vaccine confidence and complacency, vaccination knowledge, trust and attitude in health workers and health providers, coronavirus conspiracy, anger reaction and need for chaos, populist views, lifestyle, and religious influence, was examined.

Results and discussion

The results show that 60.2% of the respondents were hesitant to receive the COVID-19 vaccine. Low confidence and complacency beliefs about the vaccine (OR = 1.229, 95% CI = 1.195-1.264) and more general sources of mistrust within the community, particularly regarding health providers (OR = 1.064, 95% CI = 1.026-1.102) and vaccine developers (OR = 1.054, 95% CI = 1.027-1.082), are associated with higher levels of COVID-19 vaccine hesitancy. Vaccine hesitancy is also associated with anger reactions (OR = 1.019, 95% CI = 0.998-1.040), need for chaos (OR = 1.044, 95% CI = 1.022-1.067), and populist views (OR = 1.028, 95% CI = 1.00-1.056). The findings were adjusted for socio-demographic factors, including age, sex, education, marital status, working status, type of family, household income, religious beliefs, and residency. The results suggest the need for an effective health promotion program to improve community knowledge of the COVID-19 vaccine, while effective strategies to tackle "infodemics" are needed to address hesitancy during a new vaccine introduction program.

Influenza and COVID-19 Vaccine Concerns and Uptake Among Patients Cared for in a Safety-Net Health System

OBJECTIVES

To examine Influenza and COVID-19 vaccine concerns and uptake among adult patients in a Southern safety-net health system.

METHODS

Trained research assistants conducted a structured telephone interview from April to October 2021. Of 118 participants, mean age was 57.7 years, 63.6% were female, 55.1% were Black, 42.4% white, and 54.2% reported rural residence.

RESULTS

Among participants, 44.9% had received the influenza vaccine during the 2020 to 2021 season, and 66.1% had received the COVID-19 vaccine. Participants who received the influenza vaccine were more likely to report getting a COVID-19 vaccine compared to those who reported not getting a flu vaccine (81.1% vs 53.8%, P = .002). Black adults were significantly less likely than white adults (29.2% vs 46.0%, P = .048) and bordering on significance, males less likely than females (27.9% vs 41.3%, P = .054) to have reported receiving both vaccines. Of note, 25.4% of participants did not get either vaccine. The most common reasons for not getting the influenza vaccine were not being concerned about getting the flu (13.8%) and belief the vaccine gave them the flu (12.3%). The primary reasons for not getting a COVID-19 vaccine were concern about vaccine safety (22.5%), concern about side effects (20.0%), and belief they were not going to get sick (20.0%).

CONCLUSIONS

These findings could help direct regional vaccine messaging and clinical communication to improve vaccine uptake among underserved populations.

A cross-sectional study of the preventive health care activities of western Canadian rural-living patients unattached to primary care providers

Prevention services, such as screening tests and vaccination, are underutilized, especially by rural populations and patients without a usual primary care provider. Little is known about the compounding impacts on preventive care of being unattached and living in a rural area and there has been no comprehensive exploration of this highly vulnerable population’s prevention activities. The twofold purpose of this research was to examine rural unattached patients’ prevention activity self-efficacy and completion and to explore their experiences accessing healthcare, including COVID-19 impacts. Two thirds of patients had been unattached for over one year, and over 20 % had been unattached for over 5 years; males experienced longer unattachment compared to females. Completion rates of prevention activities were relatively low, ranging from 5.9 % (alcohol screening) to 59 % (vision test). Most participants did not complete their prevention care activities in line with the Lifetime Prevention Schedule timeline: 65 % of participants had less than half of their activities up-to-date and only 6.7 % of participants were up to date on 75 % or more of their prevention activities. Participants with higher prevention self-efficacy scores were more likely to be up-to-date on associated prevention activities but the longer patients had been unattached, the fewer their up-to-date prevention activities. Patients expressed negative impacts of COVID-19 including walk-in clinics shutting down limiting access to care. These results suggest serious gaps in rural unattached patients’ preventive care and highlight the need for support when they are without a usual primary care provider, which can be lengthy.

An (un)healthy social dilemma: a normative messaging field experiment with flu vaccinations

BACKGROUND

Influenza seasons can be unpredictable and have the potential to rapidly affect populations, especially in crowded areas. Prior research suggests that normative messaging can be used to increase voluntary provision of public goods, such as the influenza vaccine. We extend the literature by examining the influence of normative messaging on the decision to get vaccinated against influenza.

METHODS

We conduct a field experiment in conjunction with University Health Services, targeting undergraduate students living on campus. We use four posters, randomized by living area clusters to advertise flu vaccination clinics during the Fall. The wording on the posters is varied to emphasize the individual benefits of the vaccine, the social benefits of the vaccine or both benefits together. We collect survey data for those vaccinated at the vaccination clinics, and for those not vaccinated via an online survey.

RESULTS

We find that any normative message increases the percentage of students getting the flu vaccine compared with no message. In terms of the likelihood of getting the flu vaccine, emphasizing both the individual and social benefits of vaccination has the largest increase in the vaccination rate (19-20 percentage point increase). However, flu vaccinations did not reach the herd immunity threshold (70% of students vaccinated).

CONCLUSIONS

This study provides evidence that there is a pro-social component that is relevant in individual vaccination decisions which should be accounted for when designing vaccination campaigns. The results of this normative, pro-social messaging experiment could be extended to other at-risk communities where the number of background risks is much larger. This is especially relevant nowadays, as other seasonal vaccines are being rolled out and younger adults are the ones with the lowest uptake.

Associations between 5-year influenza vaccination and sociodemographic factors and healthcare access among Arkansans

Despite wide availability, only 50.2% of the United States (US) adult population and 50.3% of adult Arkansans were vaccinated for influenza during the 2020-2021 influenza season. The proportion of the population vaccinated for influenza varies by age, sex, race/ethnicity, education, rural/urban residence, and income. However, measures of healthcare access have not been adequately investigated as predictors of influenza vaccination. Using a large, statewide random sample, this study examined 5-year influenza vaccination among Arkansans by sociodemographic characteristics (age, sex, race/ethnicity, education, rural/urban residence), general vaccine hesitancy, and healthcare access (having a primary care provider, having health insurance, forgoing health care due to cost, and frequency of doctor checkups). Older age, being female, being Hispanic, having a bachelor's degree or higher, having a primary care provider, visiting a doctor for a checkup in the past two years, and lack of hesitancy towards vaccines were significant predictors of receiving influenza vaccination.

Pharmacy-Based Opportunistic Atrial Fibrillation Screening at a Community Level: A Real-Life Study

Purpose: Opportunistic pharmacy-based screening of atrial fibrillation (AF) appears effective, but the proportion of detected citizens is unknown. The aim of our real-life study was to determine rates of screening in a community population according to age group and gender. Methods: We conducted four community campaigns of pharmacy-based single-time point AF screening that involved individuals ≥65 years. We used a single-lead and hand-held device MyDiagnostick (6229 EV Maastricht, The Netherlands) that generates a 60-s ECG trace. All pharmacies of the communities (n = 54) were involved. Rates of screening were assessed on the base of the French National Institute for Statistics and Economic Studies data and were expressed as percentage and 95% Confidence interval (CI). Results: We screened 4208 individuals (Mean age, 74.2 ± 6.6 years; females, 60.2%). The screening rate in citizens aged ≥65 years was 17.2% (16.6–17.7), and higher in females than in males (17.9% [17.3–18.6] versus 16.0 [15.3–16.8], p < 0.001). The 70–74 age group showed the highest rate (25.7% [24.4–27]) compared to other groups. After 74 years, screening rates decreased steadily with age and dropped to 4.8% [3.8–6.1] in very elderly (≥90). Among the 188 (4.47%) positive screening, 117 (2.78%) showed an AF that was unknown in 53 (1.26%). Increasing age (OR: 1.05 [1.00–1.09], p = 0.04), male sex (OR: 4.30 [2.33–7.92], p < 0.0001) and high CHA2DS2-Vasc (OR: 1.59 [1.21–2.09], p = 0.0008) were independent predictors of unknown AF. Conclusion: Single-lead AF detection performed in community pharmacies result in screening one in six elderly citizens. Although male sex and elderly predicted unknown AF diagnosis, they were less involved in such designed campaigns.

How Sociodemographic Factors Impact the Utilization of Recommended Clinical Preventive Screening Services in Poland: A Nationwide Cross-Sectional Study

Cardiovascular disease (CVD) and cancer are the most frequent causes of mortality in Poland. To date, no study in Poland has attempted to analyze the impact of sociodemographic factors on the utilization of all recommended preventive services for these diseases. To address this challenge, a nationwide cross-sectional study was conducted. One thousand adults aged 18 years or older were interviewed using computer-assisted telephone surveys conducted via random selection. A representative population was obtained in accordance with existing demographics per voivodeship in Poland. We assessed whether factors such as age, gender, body mass index (BMI), net income, household size, place of residence, and education impacted the odds ratio of utilizing recommended preventive services for CVD and cancer. We determined that elderly patients receive influenza vaccination, measure blood pressure, PSA concentration, glucose and lipid profiles, and undergo colonoscopy and mammography more often than younger counterparts. Men were more often influenza vaccinated (OR = 1.56, 95% CI: 1.07–2.27) than women, while women measured blood glucose more often than men (OR = 0.62, 95% CI: 0.42–0.93). Furthermore, net income < 2000 PLN, BMI < 24 kg/m² and at least secondary education level were found to be crucial predictors of undergoing mammography (OR = 2.16; 95% CI: 1.26–3.72), cervical smear tests (OR = 1.99, 95% CI: 1.24–3.17), and lipid measurements (OR = 1.76, 95% CI: 1.07–2.91), respectively. Educating people and financial support seem to play a crucial role in implementing novel campaigns and preventive programs in Poland. Addressing each significant factor may be of paramount importance in improving the receipt of preventive services and warranting greater preventive care coverage in the Polish population.

Predictors for Actual COVID-19 Vaccine Uptake and Intended Booster Dosage among Medical Students of an Osteopathic Medical School in New York

Exploring future physicians' attitudes toward vaccination is crucial as physicians' recommendation is the top predictor for individuals to receive vaccines. This study explored the uptake of COVID-19 vaccines and the intention for future booster dose uptake among students at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM). Predictors for actual vaccine and intended booster uptake were also examined. An electronic survey was distributed to Osteopathic Medical Students (OMS I-IV) in the Spring of 2021. A total of 1331 students received the survey, with 316 responses received (24%). In total, 95.3% (301/316) of the respondents reported that they already received vaccines, while 3.1% (13/316) reported that they had not yet received a vaccine. Moreover, 88.9% of the respondents (281/316) were in favor of a booster dose, which was a strong predictor for actual vaccine uptake. We identified that the Asian race, pharmaceutical mistrust, building immunity via vaccines, adequate vaccine testing, and willingness to get non-U.S. manufactured vaccines are the most significant predictors for willingness to accept a booster dose. A very high COVID-19 vaccine uptake among NYITCOM OMS was found in our study. The study also observed a high acceptance of an additional dose of the COVID-19 vaccine in the future.

Individual differences in COVID-19 mitigation behaviors: The roles of age, gender, psychological state, and financial status

The present study examined individual characteristics potentially associated with changes in mitigation behaviors (social distancing and hygiene) recommended by the Centers for Disease Control and Prevention. Analysis of online survey responses from 361 adults, ages 20–78, with US IP addresses, identified significant correlates of adaptive behavioral changes, with implications for preventive strategies and mental health needs. The extent to which individuals changed their mitigation behaviors was unrelated to self-rated health or concern regarding the personal effects of COVID-19 but was related to concern regarding the effects of the pandemic on others. Thus, mitigation behaviors do not appear to be primarily motivated by self-protection. Importantly, adaptive changes in mitigation behaviors increased with age. However, these changes, particularly those related to the frequency of close proximity encounters, appear to be due to age-related decreases in anxiety and depression. Taken together, the present results argue against over-reliance on ‘fear appeals’ in public health messages as they may increase anxiety and depression. Instead, the present findings argue for more appeals to people’s concern for others to motivate mitigation as well as indicating an immediate need to address individual mental health concerns for the sake of society as a whole.

Factors Affecting COVID-19 Vaccination among the General Population in Saudi Arabia

Vaccine refusal or hesitancy is one of the significant issues that can have an adverse impact on people’s health and their countries’ economy. Additionally, vaccine acceptance or refusal could have a decisive role in controlling the COVID-19 pandemic. This study aims to investigate the factors affecting COVID-19 vaccine refusal and hesitancy among the general population in Saudi Arabia. The method is a cross-sectional survey using an online questionnaire, and data were collected from 1935 participants between 18 February 2021 and 1 April 2021. Out of 1935 participants aged ≥18 years and residing in Saudi Arabia, 46.9% reported their intention to receive the COVID-19 vaccine, 22.4% had received the vaccine, 9.5% did not intend to receive the vaccine, and 21.2% had not made their decision. In the multinomial logistic regression models, vaccine refusal was associated with age (OR: 0.961), nationality (OR: 0.182), monthly income of more than SAR 18,000 (OR: 2.325), chronic diseases (OR: 0.521), knowledge about the vaccine (OR: 0.937), and concerns about the vaccine (OR: 1.5). The hesitancy was associated with age (OR: 0.977), nationality (OR: 0.231), monthly income between SAR 6000 to 12,000 (OR: 0.607), chronic diseases (OR: 0.640), knowledge about the vaccine (OR: 0.907), and concerns about the vaccine (OR: 1.3). The main concerns about the vaccine were “COVID-19 vaccines are not tested enough on people”, “drug companies are interested in COVID-19 vaccine sales only”, and “COVID-19 vaccines have serious adverse effects”. Awareness programs and vaccination campaigns should consider people’s concerns and correct their misinformation.

Prevalence and Factors of the Performed or Scheduled COVID-19 Vaccination in a Chinese Adult General Population in Hong Kong

BACKGROUND

Globally, COVID-19 vaccination programs have been rolled out. To inform health promotion, this study investigated the prevalence and associated factors of performance or being scheduled to perform at least one dose of COVID-19 vaccination (PSCV) in a Chinese adult general population.

METHODS

An anonymous, random telephone survey interviewed 500 adults aged 18-75 in Hong Kong, China from 14-27 May 2021.

RESULTS

The prevalence of PSCV was 21.0%, which was significantly lower among females and those aged ≤30. Positively associated factors of PSCV included perceived protection effect of vaccination, self-perceived physical fitness for vaccination, compulsory COVID-19 testing experience, perceived need to travel, general trust toward the government, and trust toward the governmental vaccination program, while negatively associated factors included perceived low efficacy of vaccination, concerns about side effects, and chronic disease status. Furthermore, the association between sex and PSCV was fully mediated by stronger concern about side effects and lower levels of self-perceived physical fitness for COVID-19 vaccination among females than males.

CONCLUSION

Moderately low prevalence of COVID-19 vaccination was observed in Hong Kong, where there was no shortage of vaccine supply. To achieve herd immunity, health promotion is greatly warranted and may incorporate messages based on the findings of this study.

COVID-19 vaccine hesitancy: misinformation and perceptions of vaccine safety

Despite COVID-19’s devastating toll, many Americans remain unwilling to receive the COVID-19 vaccine. The authors conducted a US national survey to understand the health literacy of adults regarding the vaccine, as well as their COVID-19 beliefs and experiences. People who believed the COVID-19 vaccine was unsafe were less willing to receive the vaccine, knew less about the virus and were more likely to believe COVID-19 vaccine myths. On average, they were less educated, lower income, and more rural than people who believed the vaccine is safe. The results highlight the importance of developing clear health communications accessible to individuals from varied socioeconomic and educational backgrounds.

Intention to get vaccinated against COVID-19 among the general population in France: Associated factors and gender disparities

As the coronavirus disease 2019 (COVID-19) spreads across the world, the rapid distribution of an effective vaccine and its acceptability among the population constitute priorities for health authorities. This study aimed to document attitudes of the general population toward a future vaccine against COVID-19. We used the national COCONEL surveys conducted during the lockdown to identify factors associated with vaccine refusal, in the whole population, and separately among men and women. We investigate the role of socioeconomic and demographic factors as well as exposure to COVID-19. Among the 5,018 participants, 24.0% reported their intention to refuse the vaccine. Thinking this vaccine would not be safe, being against vaccination in general, and perceiving COVID-19 to be harmless were the three main reasons given to explain vaccine refusal. Women were more likely to refuse the vaccine, especially due to a reluctance toward vaccination in general or the perception that a COVID-19 vaccine would not be safe. Some factors associated with the intention to refuse the vaccine were the same among men and women such as a lack of prior vaccination against influenza, and concern over being infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while others differed slightly according to gender such as age, and high prevalence of COVID-19 in their region of residence. Authorities should therefore guarantee that all the necessary precautions are taken before marketing the vaccine and communicate transparently on the process of its development, and on the coverage rate required to reach herd immunity.Abbreviation: EHI: Equivalized Household Income per month; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.

When can we stop wearing masks? Agent-based modeling to identify when vaccine coverage makes nonpharmaceutical interventions for reducing SARS-CoV-2 infections redundant in indoor gatherings

As vaccination efforts to combat the COVID-19 pandemic are ramping up worldwide, there are rising concerns that individuals will begin to eschew nonpharmaceutical interventions for preventing SARS-CoV-2 transmission and attempt to return to pre-pandemic normalcy before vaccine coverage levels effectively mitigate transmission risk. In the U.S.A., some governing bodies have already weakened or repealed guidelines for nonpharmaceutical intervention use, despite a recent spike in national COVID-19 cases and majority population of unvaccinated individuals. Recent modeling suggests that repealing nonpharmaceutical intervention guidelines too early into vaccine rollouts will lead to localized increases in COVID-19 cases, but the magnitude of nonpharmaceutical intervention effects on individual-level SARS-CoV-2 infection risk in fully- and partially-vaccinated populations is unclear. We use a previously-published agent-based model to simulate SARS-CoV-2 transmission in indoor gatherings of varying durations, population densities, and vaccination coverage levels. By simulating nonpharmaceutical interventions in some gatherings but not others, we were able to quantify the difference in SARS-CoV-2 infection risk when nonpharmaceutical interventions were used, relative to scenarios with no nonpharmaceutical interventions. We found that nonpharmaceutical interventions will often reduce secondary attack rates, especially during brief interactions, and therefore there is no definitive vaccination coverage level that makes nonpharmaceutical interventions completely redundant. However, the reduction effect on absolute SARS-CoV-2 infection risk conferred by nonpharmaceutical interventions is likely proportional to COVID-19 prevalence. Therefore, if COVID-19 prevalence decreases in the future, nonpharmaceutical interventions will likely still confer protective effects but potential benefits may be small enough to remain within "effectively negligible" risk thresholds.

International estimates of intended uptake and refusal of COVID-19 vaccines: A rapid systematic review and meta-analysis of large nationally representative samples

Background

Widespread uptake of COVID-19 vaccines will be essential to controlling the COVID-19 pandemic. Vaccines have been developed in unprecedented time and quantifying levels of hesitancy towards vaccination among the general population is of importance.

Methods

Systematic review and meta-analysis of studies using large nationally representative samples (n ≥ 1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November 2020. Registered on PROSPERO (CRD42020223132).

Findings

Twenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate decreased and the percentage of people intending to refuse vaccination increased. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I² > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies.

Interpretation

Intentions to be vaccinated when a COVID-19 vaccine becomes available have been declining across countries and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available.

Funding

N/A.

COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment

Given the results from early trials, COVID-19 vaccines will be available by 2021. However, little is known about what Americans think of getting immunized with a COVID-19 vaccine. Thus, the purpose of this study was to conduct a comprehensive and systematic national assessment of COVID-19 vaccine hesitancy in a community-based sample of the American adult population. A multi‐item valid and reliable questionnaire was deployed online via mTurk and social media sites to recruit U.S. adults from the general population. A total of 1878 individuals participated in the study where the majority were: females (52%), Whites (74%), non-Hispanic (81%), married (56%), employed full time (68%), and with a bachelor’s degree or higher (77%). The likelihood of getting a COVID-19 immunization in the study population was: very likely (52%), somewhat likely (27%), not likely (15%), definitely not (7%), with individuals who had lower education, income, or perceived threat of getting infected being more likely to report that they were not likely/definitely not going to get COVID-19 vaccine (i.e., vaccine hesitancy). In unadjusted group comparisons, compared to their counterparts, vaccine hesitancy was higher among African-Americans (34%), Hispanics (29%), those who had children at home (25%), rural dwellers (29%), people in the northeastern U.S. (25%), and those who identified as Republicans (29%). In multiple regression analyses, vaccine hesitancy was predicted significantly by sex, education, employment, income, having children at home, political affiliation, and the perceived threat of getting infected with COVID-19 in the next 1 year. Given the high prevalence of COVID-19 vaccine hesitancy, evidence-based communication, mass media strategies, and policy measures will have to be implemented across the U.S. to convert vaccines into vaccinations and mass immunization with special attention to the groups identified in this study.

Factors Associated with Survey Non-Response in a Cross-Sectional Survey of Persons with an Axial Spondyloarthritis or Osteoarthritis Claims Diagnosis

Non-response in surveys can lead to bias, which is often difficult to investigate. The aim of this analysis was to compare factors available from claims data associated with survey non-response and to compare them among two samples. A stratified sample of 4471 persons with a diagnosis of axial spondyloarthritis (axSpA) and a sample of 8995 persons with an osteoarthritis (OA) diagnosis from a German statutory health insurance were randomly selected and sent a postal survey. The association of age, sex, medical prescriptions, specialist physician contact, influenza vaccination, hospitalization, and Elixhauser comorbidity index with the survey response was assessed. Multiple logistic regression models were used with response as the outcome. A total of 47% of the axSpA sample and 40% of the OA sample responded to the survey. In both samples, the response was highest in the 70-79-year-olds. Women in all age groups responded more often, except for the 70-79-year-olds. Rheumatologist/orthopedist contact, physical therapy prescription, and influenza vaccination were more frequent among responders. In the logistic regression models, rheumatologist/orthopedist treatment, influenza vaccination, and physical therapy were associated with a higher odds ratio for response in both samples. The prescription of biologic drugs was associated with higher response in axSpA. A high Elixhauser comorbidity index and opioid use were not relevantly associated with response. Being reimbursed for long-term care was associated with lower response-this was only significant in the OA sample. The number of quarters with a diagnosis in the survey year was associated with higher response. Similar factors were associated with non-response in the two samples. The results can help other investigators to plan sample sizes of their surveys in similar settings.